Dr. Socorro Gross-Galiano Assistant Director Ministerial Meeting on HIV and Development in Latin America and the Caribbean ECOSOC - Annual Ministerial Review Jamaica, 4-6 June 2009 Sustained Response.
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Dr. Socorro Gross-Galiano Assistant Director Ministerial Meeting on HIV and Development in Latin America and the Caribbean ECOSOC - Annual Ministerial Review Jamaica, 4-6 June 2009 Sustained Response to HIV: Financial Challenges Where does the financing for the response come from? We should sustain our support to countries with funding gaps and avoid setbacks on HIV financing already achieved Financing Composition ofwhat HIVwe in have seelcted LAC in selected countries Domestic Doméstico Source: UNAIDS, 2008 ( last available year) International Internacional ua y Ur ug Pe ru Me xi c o Pa na ma Pa r ag ua y ras nd u Ha iti Ho Ar ge nti na Ba ha ma s Ba rba do s Bo liv ia Br az il Ch ile Co lom bia Co sta Ric a Cu ba Ec ua do El r Sa lva do Gu r ate ma la 100.00% 90.00% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Sustained Response to HIV: Financial Challenges What is the roadmap ? •Prevention (Young People / Risk Groups, Vertical Transmission) •Early Detection •Interventions that address the social and epidemiological reality •PHC based Health Systems with positive synergies •Mechanisms to improve interventions, efficiency and reduce costs •Strengthen inter-sector collaboration •Eliminate stigma and discrimination Components of a Sustained HIV Response Protecting achievements Making progress in areas lacking ade Health sector Provides important role of the response – leads inter-sectoral work, key for a sustained & comprehensive response. Response should be maintained and expanded IT IS URGENT! Prioritize prevention reducing rate of new infections, targeting high-risk populations, work on stigma and discrimination and using resources rationally. New infections will require treatment Sizable number of infected people are still without access to treatment Innovations in therapeutic appro People receiving ART will continue needing them ( more expensive plans) For what? Estimates correspond to: Necessary to introduce mechanisms that reduce costs of providing services at all levels of the system and barriers to access - including out-of-pocket expenditures, stigma and discrimination Human Resources Materials Equipment Infrastructure Needed for the delivery of interventions that allow meeting of targets … the challenge is not limited to financial resources! The financial crisis… Finds us with some of our health systems fragmented This has an impact on •The rational use of resources •The response capacity by the health sector … including HIV! Reforms in the Re-orientation of PHC based Health Systems HIV Universal Coverage Organization of Services Strong health systems = Robust response Leadership Reform Public Policies HIV is controlled, benefits are achieved, LIVES ARE SAVED Progress on ARV Access to prevent mother to child transmission in LAC Due to insufficient coverage, an estimated 12 100% 90% 80% 70% Impact on children: 60% 50% 40% 26% 33% 36% 36% 30% Lack of opportunity from birth; Vulnerability Social responsibility and of health systems 20% 10% 0% 2004 2005 2006 2007 % of HIV+ pregnant women % mujeres embarazadas VIH+ q'ARV recibenfor ARVPMTCT para PTMI that receive Deliver Social Protection Cover treatment costs Costs of not preventing Maternal-Child Transmission Costo TARV Niño los 2 m eses Costpor of ART perdesde child from 15years añosof(en 2 hasta monthslos to 15 age US$) (US $) 160,000 120,000 80,000 40,000 0 Precios del Fondo Estratégico Prices Strategic Fund Precios negociados sinwithout aplicación de precios Prices negotiated the internacionales deofreferencia application international reference pricing The cost of treatment with ARV for 15 years Cost of child preventing per infected varies a case of mother to child transmission is $25,483 to $140,222at(US) estimated US$500 canCost be ARVCost range minimized if total in the Region: prevention is provided by anmillion integrated $313 & maternal care network $ 1.7 billions (US) . Options to reduce and contain drug and resource costs Purchase of ARV Precios de adquisicion de ARV en dos escenarios Politicos: innovadores Vs Two scenarios - Innovators (Chile) versus Generics (Peru), Genericos, bajo un mismo sistema de compras centralizadas under the same centralized purchasing system Dolares americanos (US$) (US$) US Dollars 3.500 3.000 2.500 PERÚ 2.000 1.500 CHILE 1.000 0.500 0.000 Lo p in a vi r/ R Did a no s in ito n av i r a Ab Zi d a ca ov u v ir di n a/l a m iv u di na Efa vire nz - ca p 60 0 mg Difficulties in pharmaceutical markets Low access by most vulnerable populations Lack of regulation to improve access to drugs Insufficient strategies to ensure Limited dialogue among interested par Coordination and inter-sectoral Now more than ever! collaboration Critical points in the intersectoral collaboration EDUCATION Monitoring the Inter-ministerial Declaration of Mexico at the national level LABOUR Links with the labor sector We need to JUSTICE Protection of Human Rights invest in FINANCE & TRADE Protect public health & ensure equitable access to drugs & other products collaboration & SOCIAL SECURITY Include children orphaned by HIV coordination CIVIL SOCIETY Coordination with civil society organizations PRIVATE SECTOR Prevention, protection and inclusion of people affected by HIV Recommendations To cooperation and financing partners: Promote utilization of strategies and coordination mechanisms Harmonize collaboration mechanisms and lessen demands on co Collaborate with countries to improve cost & efficiency Promote interventions and investments to strengthen local Recommendations To social policy makers : Include people affected by HIV, in social protection programs inclu Allocate public spending to sustain achievements Prioritize vulnerable & high risk populations in a addressing Recommendations To national actors Revisit PHC and coordinate an integrated health system response Re-prioritize preventive interventions targeting high-ri Mainstream sex education Establish an early warning system to minimize treatment interruption Recommendations To national health authorities: Revitalize leadership role in policy-making, coordination, and mana Revise model of care for HIV including organization & delivery; Conduct critical analysis and data analysis to identify deficiencies, Define needs for long-term reforms based on analysis results Recommendations To health services management Coordinate complementary interventions, such as the promotion of Incorporate actions within comprehensive and integrated care frame Protect and develop Human Resources for Health to maintain its qua Recommendations To Media Emphasis on prevention stigma and discrimination Promote voluntary testing and counseling Recommendations AT ALL LEVELS! PROMOTE solidarity respect and the elimination of stigma and discrimination Thank You! ¡Gracias! Merci! Muito Obrigado!